What the U.S. Can—and Can't—Learn From Israel's Ban on Ultra-Thin Models

A new Israeli law prohibits fashion media and advertising from using Photoshop or models who fall below the World Health Organization's standard for malnutrition.

Aya Barazani, who suffers from anorexia, points at Israeli fashion models Noga Dekel, left, and Shira Amikam, as fashion photographer Adi Barkan looks on during a photo shoot in his studio for a campaign promoting anorexia awareness. / AP

On Monday, March 19, the Israeli parliament passed
legislation ubiquitously known in the country as the Photoshop laws. The new
regulations on the fashion and advertising industry ban underweight models as
determined by Body Mass Index and regulate Photoshop usage in media and
advertising. Abroad, the laws have
opened new discussion on a government's right to intervene in these two
industries.

The legislation focuses on two elements of the fashion
industry that have long drawn criticism for their effects on women and,
especially, girls: ultra thin models and the use of Photoshop to make women
appear impossibly thin in advertisements. The measure has been controversial
within Israel for raising the question of where free speech bumps up against
the fashion industry's responsibility -- and its possible harm -- to its
customers' psychological wellbeing. It has also raised the question of whether
other countries might consider similar measures to address what many activists
consider a root cause of an epidemic of anorexia and other eating disorders.

Rachel Adato, an Israeli parliament member with a background
in medicine, as well as prominent photographer and fashion model agent Adi
Barkan, championed the law.

Barkan has been working to help girls with eating disorders
since he discovered the epidemic firsthand in 1997, when a 15-year-old girl
named Caty asked to meet with him to understand what a "model should look
like." She arrived at the meeting five-foot seven-inches, weighing 79 pounds.
"It was obvious she required hospitalization," Barkan told me over email. Caty
was hospitalized for 5 months, during which time Barkan says he visited daily.

A few months after Caty was released, Barkan appeared as a
guest on an Israeli lifestyle TV show to discuss his work. "During the
interview the hostess told me she had a surprise for me," he recalled, "a girl
who claims I saved her life, and then Caty came in and told her story."

" I'm sure we'll change
the attitude all over the world."

"The following morning there were 174 messages on my
answering machine from anorexics and bulimics asking for help. I met all of
them."

An icon in the fashion world, Barkan tried to deal with the
issue from the inside: appealing for change within his beloved industry, to an
overwhelmingly negative response of doubts, jabs, and apathy.

"I became immersed in this world very quickly. I gave up the
agency and photography and delved into the dark world of anorexics and
bulimics," he said. "I realized that only legislation can change the situation.
There was no time to educate so many people, and the change had be forced on
the industry. There was no time to waste, so many girls were dieting to death."

Working with members of the Israeli parliament, he met
Adato. The pair spent two and a half years working on the legislation:
presenting scientific articles to the Israeli parliament and demonstrating the
connection between media portrayals of peoples' bodies and eating disorders.
The law forbids underweight models from working on advertisements. A doctor
must certify that a model can be employed by measuring him or her and
determining that the model's Body Mass Index (BMI) is at or above 18.5, which
the World Health Organization defines as indicative of malnutrition. A
five-foot, seven-inch individual, for example, must weigh at least 118 pounds
to work as a model in Israel. On March 19, the bill was easily passed by the
majority of the parliament.

Adato explained the legislation and its easy passage simply:
eating disorders are an epidemic in this small country, and the government had
the responsibility to take action to protect the vulnerable.

"In Israel, there are 1,500 new cases of eating disorders
every year, and 10 percent of teenagers suffer from eating disorders," she told
me. Israel's population is only 7.5 million, making the high rate especially
alarming. "We also know that the first cause of death in the age group of 15-24
is anorexia, so when you hear those numbers, they're frightening."

There's a big difference between health and weight, as Adato
was quick to note, and the BMI value, though imperfect, is the best way to
define a an underweight individual across international standards. "It's easy
for me to adopt the international value that was adopted by the WHO as a
physician and as parliament number. I don't talk about health; I'm talking
about underweight."

Unsurprisingly, there's been backlash from some modeling
agencies in Israel. "Agencies say 'all of our models are eating perfect they're
just skinny' but it's not true and we know it's not true," Adato insisted.
"Only 5 percent of girls that are under 18.5 BMI are girls that are eating well
in Israel."

The new law also stipulates that any ad which uses
airbrushing, computer editing, or any other form of Photoshop editing to create
a slimmer model must clearly state that fact. Advertising campaigns created
outside of Israel must comply with the legislation's standards in order to
appear here.

The first legislation of its kind, this law and its
architects have gained an extraordinary amount of international media
attention. Within six days of the bill's passage, Adato says she received 456
media inquires from all over the world. "According to interest, I'm sure this
will make some change," she told me. "I'm sure we'll change the attitude all
over the world, that this is a disease and people are dying from anorexia and
people need to keep this in mind and in public view."

Daniel Le Grange, professor of psychiatry and director of
the eating disorder program at the University of Chicago, believes that
Israel's legislation on Photoshop could have an even greater impact than its
BMI regulations. "No one is that perfect, no one has Photoshop on their faces
all day long," he said, frustration clear in his voice. "It's very discouraging
for our patients who for one reason or another desire that perfection, and they
page through every magazine and see every face that's perfect. It's easy to get
scooped up that, 'I should look perfect because they all look perfect.'"

Unrealistic portrayals of beauty in fashion spreads may not
be the ultimate cause of the eating disorder epidemic -- but they are a
contributing factor.

"Developing an eating disorder is a complex process in terms
of specific constellation of personality traits that one's born with," La
Grange explained. "Genetic, environmental, societal things have to come
together in a vulnerable individual, so it's not just one piece that makes it
possible."

"What this [legislation] can achieve is that this vulnerable
individual is protected from environmental things -- she may not develop [an]
eating disorder, but since they are so complex it will be difficult to say," Le
Grange explained.

The media buzz surrounding the new legislation may be one of
its biggest benefits, argued David Herzog, a professor of pediatrics at Harvard
Medical School and director of the Harris Center for education and advocacy in
eating disorders at the Massachusetts general hospital. "I think the more
attention to this area the more likely we are to the change."

Still, turning that talk into action -- especially government
action -- can be tricky and controversial. What is the state's role in
regulating images that reinforce socially harmful perceptions? At what point
does an image become too dangerous to publish? Where is the line between the
public interest and the free speech rights of media and advertisers?

"I'm supportive of government intervening to provide better
health for public but I also want to be careful about what we're asking the
federal government to legislate," Herzog said. "So how do you try to limit the
negative forces? I want to keep the dialogue going, they're onto something
that's important, we want to do things that support the healthy development of
our nation."

Donald Downs, a professor at the University of Wisconsin and
an expert on the First Amendment, says that it would be very tough to pass
something like Israel's law in the U.S. Congress. "In the U.S., it would be
hard to justify this type of law on either legal or normative policy grounds,"
he said. "The Israeli law is paternalistic in that it prohibits something
because of the effect it might have on others in the longer term."

The complexity of eating disorders can make it difficult to
justify complete legislation. "In addition to the legal aspect of the case,
such a law would be in tension with American cultural support for free speech
in cases in which the harm is not direct or clear," Downs went on. "We are much
more wary of giving the state the power to prohibit expression in such contexts
because the harm is not usually direct."

The more accepted approach for activism in the United States
has been to put public pressure on the fashion industry to change, without
government intervention. Some have answered the call for change, such as Dove,
which launched the Campaign for Real Beauty in 2004 and a viral video entitled
"Evolution" in 2006, which shows the
unbelievable transformation of an "ordinary" woman into a Photoshopped
super-woman. Its model of positive advertising has brought the brand attention,
but it doesn't appear to have caught on in the wider advertising or media industries,
which are still Photoshopping away.

In 2007, an industry-wide fashion trade association called
the Council for Fashion Designers of America (CFDA) formed ahealthinitiative that, according to
its website, "is about awareness and education, not policing. Therefore, the
committee does not recommend that models get a doctor's physical examination to
assess their health or body-mass index to be permitted to work. Eating
disorders are emotional disorders that have psychological, behavioral, social,
and physical manifestations, of which body weight is only one."

The CFDA, spokespeople for which did not return requests for
comment, epitomizes the failure of the fashion industry to protect their
employees from within, which is what Barkan rallied for -- and also failed to
achieve -- in Israel before pushing legislative action. Why educate models and
designers about the existence of these diseases and then explicitly not
recommend a visit to the doctor?

"I believe this small movement that began in Israel is like
a stone thrown into the lake. The waves can reach very far," Barkan said. "I
went against my industry, this is clear. And no matter how high the cost I
personally paid, it was worth everything. No commercial success for my agency
can be compared to saving lives. I'm not talking about a drastic change, only a
small difference between thin and too thin, between life and death."

According to a 1999study published in Pediatrics,
about two thirds of American girls in the fifth to 12th grades say that
magazine pictures influence their image of an ideal body; about half of girls
in those grades said the magazine images made them want to lose weight. A 2009 American Journal of Psychiatry studydetermined
that the mortality rates for anorexia nervosa and bulimia nervosa are about
four percent, the highest rates for any mental disorder. When a 14-year-old
girl delivered a 25,000-signature petition this week to Seventeen asking them
to curb their use of Photoshop, the magazine issued a press statement that
congratulated the girl on her ambition but wasconspicuouslysilent
on changing their editorial practices. Maybe Israel's BMI-indexing,
Photoshop-regulating law isn't right for the U.S., with our established speech
protections and anti-regulation sensitivities. But, if not that, then what?